The 5 P’s of Nursing

As times change and the healthcare industry continues to be impacted by the COVID-19 pandemic, it is more important than ever to be mindful of efficiency. Efficiency while making your rounds, as well as clustering care, are some of the best ways that a nurse can save time. Understanding and implementing the 5 P’s of Nursing when completing rounds not only promotes positive patient outcomes and experiences, but also increases nursing staff satisfaction rates.

The 5 Ps

1. Pain
2. Position
3. Potty or Personal Hygiene
4. Periphery
5. Pump

How can you become more efficient when completing rounds? You can start by ensuring you understand and know how to implement the 5 P’s of Nursing. When making your rounds, always begin by introducing yourself. Then, be certain to describe what you are doing out loud for the patient, so that he or she  will feel comfortable and well-informed. Finally, it is time for the 5 P’s. 

What are the 5 P’s of Nursing?

• Pain
• Position
• Potty (or Personal Hygiene) 
• Periphery 
• Pump

The 5 P’s of Nursing is a mnemonic device that nurses use to remember what to check on during their hourly rounds. Each “P” stands for a word; the word helps nurses recall the correct questions to ask of their patients to ensure they have all of the information they need.  

Let’s break down each component of the 5 P’s of Nursing and learn more about each one. 

Pain 

You can ask: 

• Do you have any pain?

It is extremely important that nurses are assessing and addressing any potential pain that their patients are experiencing. That means it is critical for you to play an active role in ensuring that any expressed pain or discomfort is relayed to the physician. Also, from a patient’s perspective, feeling heard is an essential part of his or her experience at your healthcare facility.

Position 

You can ask: 

• Are you comfortable?
• Do you need to be repositioned?
• Can I adjust your pillows or blankets?

Patients may need to be moved from time to time; this is essential not only for their own comfort, but also to decrease other health issues which may result from prolonged periods without movement. The prevalence of hospital-acquired ulcers and injuries, along with problems such as blood clotting and muscle weakness, can be dramatically reduced by performing the correct interventions during hourly rounds. 

Potty or Personal Hygiene

You can ask:

• Do you need to use the bathroom?

It’s not uncommon for patients to contract a urinary tract infection (UTI) during a hospital stay. In fact, UTIs are one of the most common hospital-acquired infections one can receive during a hospital visit. Whether it is from a catheter, poor personal hygiene, a blockage, or something else, there are a variety of reasons that a hospital stay can result in a UTI – some of which are preventable and can be performed as a part of the 5 P’s during hourly rounds. 

For many patients, simply asking the question, “Do you need to use the bathroom?” is enough. However, there will be instances where you may have to further investigate and ensure patients do not need to relieve themselves. There may also be times when a patient is not able to tell and may need your assistance. 

Periphery 

You can ask: 

• Do you have all of your personal belongings within reach?
• Do you need me to move anything?
• Can you reach everything you need?

Patients often have multiple personal items with them during their hospital stay; the longer their stay, the more belongings they usually have. Depending on the patient, there will be instances where you will be asked to move items around the room for the patient’s ease of access. It is best practice to get ahead of the patient’s request by asking him or her if there is anything that needs to be moved around. 

In fact, this can be the most impactful P of the 5 P’s of Nursing, simply because it directly influences the patient’s experience. If nurses are responsive to peripheral requests, it both makes a patient’s stay easier and also improves the chances of a positive report from a follow-up survey. 

Pump 

You can ask:

• Are all of your pumps or other equipment properly plugged in?

According to the Institute for Safe Medication Practices, IV sites and pumps must be checked every two hours – or anytime a nurse comes in to reposition a patient or fulfill another patient request. Obviously, your specific facility’s protocol might have been modified, so you should always check with your direct supervisor if you are unclear on exact times. In general, though, and regardless of protocol, pumps and equipment should be checked very frequently. 

When you are finished with the 5 P’s, that doesn’t mean it is time to rush out of the room! Don’t forget to ask your patients if there is anything else you can do while you’re there. Assure them that you have the time to attend to their needs. Take a moment to focus on just this patient and how he or she is feeling. 

Why the 5 P’s of Nursing? 

The “why” behind the 5 P’s isn’t just about increasing efficiency; it is also about promoting safety, bringing nurses back to the bedside, builds the patient’s trust, and improves clinical outcomes. For healthcare facilities and healthcare workers, a deep understanding of the 5 P’s and thorough, consistent implementation of the 5 P’s leads to measurable results. 

Numerous studies have shown that ensuring patients have access to their personal belongings, are comfortable, and have their bathroom needs met reduces hospital fall rates by more than 50%. Many hospitals that do implement the 5 P’s have shown a decline in skin breakdowns and pressure ulcers of over 10%. And following the 5 P’s with care can even significantly reduce call light usage – by over 40%. The improvement in patient satisfaction is clearly important, but perhaps the biggest benefit with call light reduction is the decrease in walking time for nurses and the resulting improvement in job satisfaction due to not being constantly interrupted. 

The biggest obstacles for hospitals when executing the 5 P’s and other best practices of hourly rounds are a lack or disorganization of leadership team commitment, a lack of staff training, a lack of communication boards, and an inability to quantify or analyze results. Staff culture surrounding changes can also contribute to why hospitals are inconsistent with hourly rounds and the 5 P’s. 

But it is possible to make an impactful change by getting  your team bought in and focusing on the results. Make sure the rest of your healthcare team is on the same page when it comes to the 5 P’s of Nursing, and hold each other accountable to ensuring that positive patient outcomes are met. 

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